Patients travel to Los Angeles for hemifacial spasm surgery

More patients are seeking microvascular decompression in Los Angeles for hemifacial spasm, a condition that often gets treated first with Botox but may have a surgical fix. Dr. Aaron Cohen-Gadol says hundreds of cases and remote second opinions are drawing patients from across the U.S. and abroad.

Why it matters: - Hemifacial spasm can disrupt speaking, eye opening and daily life for years, even though the condition is not life-threatening. - Microvascular decompression targets the root cause, which can offer a durable cure instead of ongoing symptom management. - Patients who want a long-term solution are increasingly traveling to Los Angeles for that surgery.

What happened: - Dr. Aaron Cohen-Gadol, a Los Angeles-based neurosurgeon, has performed more than 600 microvascular decompression procedures for hemifacial spasm and trigeminal neuralgia. - Patients are coming from across the U.S. and internationally for surgery and consultation. - Dr. Cohen-Gadol performs these operations at Cedars-Sinai Medical Center and Saint John's Health Center in Los Angeles, where he leads the ATLAS Institute of Brain and Spine.

The details: - Hemifacial spasm is usually caused by a blood vessel pressing on the facial nerve as it exits the brainstem. - Botox and medication do not correct that compression. They temporarily reduce muscle overactivity. - Botox effect typically lasts three to six months and must be repeated. - Long-term Botox use can lead to facial weakness, cosmetic asymmetry and ongoing irritation from repeated injections. - Microvascular decompression moves the offending blood vessel off the facial nerve and places a cushion between them. - More than 80% of appropriately selected patients get complete, lasting relief after the operation. - Many patients improve within days to weeks, and results can last for years. - Most patients stay in the hospital for a few days and return to non-strenuous activity within one to two weeks.

Between the lines: - The article argues that surgery should be discussed earlier, not only after years of repeat injections. - Fear of brainstem surgery appears to be a major barrier, but the piece says experienced centers have a well-characterized safety profile. - The article also suggests surgeon experience is a key differentiator because the operation depends on identifying the compressing vessel and minimizing nerve manipulation. - Dr. Cohen-Gadol says the goal is to replace fear-based assumptions with information when patients choose between repeat Botox and a single operation.

What's next: - Dr. Cohen-Gadol's practice offers remote second-opinion review of imaging and symptom history before patients book travel. - Patients can have in-person or virtual consultations to determine whether they are good surgical candidates before deciding to come to Los Angeles. - The office directs patients to call (310) 626-1312 or visit the practice website for more information. - The practice also points patients to Neurosurgical Atlas, Facebook and X for social media updates.

The bottom line: - For selected patients with hemifacial spasm, microvascular decompression is being positioned as a one-time surgical option that may outperform years of repeat Botox.